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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CPT 2027 Is Out: 299 New Codes, a Maternity Overhaul and a Plan for January
The AMA released the CPT 2027 code set on September 9, 2026, with 299 new codes, 74 revisions and 80 deletions effective January 1, 2027. Here is what changed, who it affects most, and the twelve-week plan we use to get charge masters, templates and payer contracts ready.
Modifier 22 and Modifier 51: Unusual Services, Multiple Procedure Reductions
One modifier asks for more money and one tells the payer to pay less, and practices get both wrong in the same ways. Here is how modifier 22 and modifier 51 actually work: the multiple procedure reduction math, the codes that never take 51, and the documentation payers want before they pay extra for 22.
The October 1, 2026 NCCI and HCPCS Quarterly Updates: What to Load Beside ICD-10
Everyone is watching the 190 new diagnosis codes arriving October 1. Fewer practices notice that the NCCI edits, the MUE table, the HCPCS Level II file and the Part B drug pricing file change the same day. Here is what CMS posted in September and how we load all four without breaking October claims.
Common Credentialing Delays and How Practices Can Prepare for a New Provider
Most payer enrollment delays are caused before the application is submitted. Here is what payers reject, what they wait for, a realistic timeline by payer type, and the preparation checklist to start the day an offer is accepted.
Telehealth Across State Lines: Licensure, Payer Rules and Compact Options
A video visit with a patient who is sitting in another state is practicing medicine in that state. Here is how we handle telehealth across state lines: where the license has to be, what Medicare, Medicaid and commercial plans require, the DEA rules for prescribing, and which licensure compacts are worth the paperwork.
Principal Care Management 99424 to 99427: How It Differs From CCM, Who Bills It
Principal care management pays a specialist for the between-visit work of managing one serious condition, and most specialty practices never bill it. Here is what 99424 to 99427 require, how the time rules differ from chronic care management, and the documentation that survives an audit.
Credentialing in September for January: Revalidations, Contracts, New Plans
January 1 is when payer contracts renew, plan networks change and revalidations that were ignored all year come due. Here is the September credentialing review we run for practices, with the checks, the deadlines and the file you should be able to produce for every provider.
OB Global Package Billing and Well-Woman Visits: What Is Included, What Is Not
The obstetric global package pays one fee for months of care, which is exactly why it gets billed wrong. Here is what 59400 and its siblings include, when the antepartum-only codes 59425 and 59426 apply, how to split a pregnancy across two payers or two practices, and how well-woman visits differ from a problem visit.
The Fourth-Quarter Denial Sweep: Appeal What You Can Before Deadlines Close
September is the last comfortable month to rescue denials from the first half of the year. Here is how we run a fourth-quarter denial sweep: which remark codes to pull first, how to sort by appeal deadline instead of dollar value, and the write-off rules that keep the list honest.
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